A method for the treatment of benign tumors of the urethra associated with urogenital infections
(57) Abstract:The invention relates to the venereal diseases and urology, and is intended for the integrated treatment of benign tumors of the urethra associated with urogenital infections. Comprehensively implement the immunotherapy of human leukocyte interferon in the form of intramuscular injection of 500 thousand UNITS a day, a course of 10 injections, with the appointment amid immune antibiotic Unidox and Vilprafen in the form of repeated 10-day course of pulse therapy with intervals of 3 days using low-intensity laser radiation with a wavelength of 0.65 μm, an output of 30 mW for 5-10 minutes Method can improve the efficiency of complex treatment of benign tumors of the urethra associated with urogenital infections. The invention relates to medicine, namely to venereology and urology.Benign neoplasms of the urethra associated with urogenital infections are one of the complex medical and social problems because of the difficulty of diagnosis and treatment. Often after treatment with known methods they recur again and often reborn in rokicie urogenital infections are conducive environment for the development, recurrence and slamonline benign neoplasm of urethra (Ptochos M. P. Atypical epithelium of the urinary bladder under the influence of mechanical factors. Collection: "proceedings of the Academy of medical Sciences of the USSR. Oncology issues", vol. 1, Moscow, Medgiz, 1949, S. 204-211).The main method of treatment of benign tumors of the urethra associated with urogenital infections, is the combined use of antibiotics and various destructive methods (resection, cautery pencil Liapis, electrocoagulation, laserodestruction) (Vasiliev A. I. Ureteroscopy and endourethral surgery, Moscow, Medgiz, 1955, S. 68-81).Searing neoplasms by Liapis has led to stunted growth of granulation tissue. However, after cessation of exposure granulation tissue continued growth further (Tsulukidze A. P. Benign tumors of the urethra. Surgical diseases of the urinary and genital organs, Moscow, Medgiz, 1955, S. 66-68).Various methods of surgical treatment (excision formations, partial resection of the urethra together with education) are radical, but very traumatic (A. Kushelev that is Way superior C.). After treatment develop urethral stricture, incontinence, deformation of the urethra and the prolapsed mucous.Similar to the inventive method, the authors propose a method for the treatment of polypous growths using a specially developed technique surgical removal in combination with the subsequent electrocoagulation (Pavlyuchenko C. E. Polypous education of the female urethra and their treatment, Stavropol, 1970, S. 75-78). After local anesthesia 5-6 ml of 0.5% solution of novocaine produce dilatation of the urethra using a set of urethral bogey or extenders Hagara. When maximally extended the urethra polypous education firmly fixed with a Kocher clamp and lifted up, after which the incision of the mucosa of the urethra on the entire thickness from both sides of the wedge is excised. The wound after excision of urethral exposed to short-term electrocautery. The technique is radical, but often leads to late postoperative complications (strictures and deformation of the urethra).According to the authors, the prototype of the proposed method is a method of treatment of high-intensity laser radiation polyps in the urethra (Weinberg H. S., Wisniewski, A. A., Lichter, M. C. Application of the manhole is 7, N 2, S. 44-47). After conducting local infiltration anesthesia applied surgical excision of urethral polyp with CO2-laser. Use the diameter of the focused laser beam 1 mm, the wavelength of 10 μm, a continuous emission mode and a power of 20 watts. This technique, despite the minimum number of postoperative complications, is not radical. And the absence in the treatment of antibacterial drugs and immunomodulators does not lead to the elimination of infections and therapy of chronic inflammation that may be the cause of recurrent tumors of the urethra.The authors propose their own method of complex treatment of benign tumors of the urethra with the use of low-intensity (therapeutic) red laser radiation apparatus AZOR-2K", antibiotics (UNeDocs and vilprafen) in the form of repeated 10-day course of pulse therapy and systemic use of human leukocyte interferon (CLI).Comprehensive treatment began with the immune CLI in the form of intramuscular injection of 500 thousand UNITS a day, for a course of 10 injections. On the background of immune correction was prescribed antibiotics in the form of repeated 10-day korody, at the rate of 2.0. After three days of interval - vilprafen 0.5 g 2 times a day after meals, at the rate of 10.0.For local therapy was used endourethral low-intensity red laser exposure apparatus AZOR-2K". Treatment was begun with the first day of antibiotic therapy for urethral method through a special nozzle N 10 through the emitter To 30 (with output power of 30 mW and an efficiency of 40-60%) apparatus AZOR-2K" (decision of the Committee on new medical technology health Ministry from 08.11.93, Protocol No. 9, THE 9444-001-34611264-95, Certificate ROSS RU TH 46 IN 01045) in a day, in the course of 15 treatments. The procedure was carried out as follows. The head of the penis was freed from the flesh and, holding the fingers of the left hand, right hand gently and slowly injected transurethrally nozzle N 10, enshrined in the emitter 30 and processed pre-sterile sea buckthorn oil. Next I set the frequency in the CW mode, the wavelength of 0.65 μm and an output power of 30 mW. Following the chosen methodology, carried out the procedure within 5-10 minutes.Under our observation was 36 men aged from 24 to 63 years, with disease duration from 1 to 10 years. Clinical manifestations of aspermia, disorders of sexual function and neurotic disorders. All patients had previously received treatment for a variety of surgical methods.Urethrocystoscopy on flexible fiberscope "URF-P2" company "OLYMPUS" made it possible to diagnose all patients neoplasm of urethra in various departments: 6 (16,67%) retrocalcaneal, 9 (25,00%) collicular, 11 (30,56%) in onion, 7 (19,44%) in the hanging part 3 (8,33%) capitate Department.All tumors were subjected to histological examination to exclude malignant process.Microbiological examination methods of DFA and PCR revealed in all patients with urogenital infections. Chlamydia - with 58.33% of patients, mycoplasmosis - 38,89%, ureaplasmosis - 22,22%, gonorrhoea - 5,55%, including 41,67% of patients the combination of two or more infections.Immunological studies have established the immunosuppression affecting interferonogenez, inhibition of T-cell immunity and early activation of lymphocytes.After treatment a significant decrease or complete disappearance of the "urethral" complaints from 91,66% of patients. Etiological cure bacterial infections observed in 97,22% of patients.Thus, the method has a qualitatively new approach to high efficiency in the treatment of tumors of the urethra, with no recurrence and is accompanied by recovery from a bacterial infection and correction of immunological parameters.Example. Patient T., age 37, (outpatient map N 321/00), he complained of pain during urination and split stream of urine, pain during ejaculation. Considers himself ill for 8 years, when first appeared split urine stream. To the doctor did not address. Notes the frequent change of sexual partners. Three years ago, pain during ejaculation, and then turned to the urologist. After conducting dry urethroscopy found a tumor in retrocalcaneal Department. Produced circular resection followed by postoperative coagulation of the wound. In the last 6 months all the symptoms resumed.External genitals are developed correctly. The urethral sponge is slightly hypermonogenic. The scrotal organs without pathology. When examination of scrapings from the urethra - leukocytes 10-12 p/al, PCR methods and MIF detected chlamydia and Mycoplasma. When finger transrectal study - prostate diffuse uvelicheniya prostate gland leukocytes in 20-30 p/SP, lecithin grain 8-10, violation of the phenomenon of crystallization of the I centuryThe transrectal us prostate cancer: heterogeneity echoes due to alternating Hypo - and hyperechoic areas. Extension periprostatic veins. Urethrocystoscopy on the fiberscope company "Olympus". Bladder: vascular pattern is reinforced, trabeculoplasty expressed, the mouth of the ureter slit, not deformed, education and defects on the mucous membrane absent; posterior urethra - the presence of transient infiltration, seed tubercle increased in retrocalcaneal the Department determines bright pink education coachhouse surface on the broad foot in diameter 4x5 mm; anterior urethra is the Central figure in there, vascular pattern is not expressed, mucous balsavage color, inflamed glands of Littre and crypts of Morgagni, in their mouths purulent tube.The results of histological examination of biopsy material: stratified squamous epithelium, connective tissue framework dense, with a small number of narrow vessels, poor cellular elements.The immunological: CD4= 0,24109/l; IRI= 1,1; SD20= 0,6109/l; SD3= 1,06109/l; phosphoinositides in SD3and SD20- 95,6 μm phosphorus/mmol/l and 81.2 medias. Mycoplasmosis. Chronic total urethritis (colliculi, solid infiltration, littleit, morganii). Chronic lung prostate. Polyp retrochallenge Department.Treatment: 1 round - intramuscular injections of 500 thousand UNITS of human leukocyte interferon, one day, in the course of 15 injections, unidox (2,0 course); endourethral application of low-intensity red laser radiation apparatus AZOR-2K", every other day (at the rate of 10 treatments).After a 3-day interval - round II: vilprafen (10.0 per course), the continuation of intramuscular injection of CLI (at the rate N 15) and endourethral application of low-intensity red laser radiation apparatus AZOR-2K" (at the rate of N 10).After the first 2 sessions significantly decreased pain in the urethra. Complete cessation of pain and dysuric disorders achieved by 6 procedure. At the same time a marked decline in the size of the prostate, improving its tone, reducing the number of cells in the gland secretion and the scrapings from the urethra. By the end of second year (25 days of treatment) the patient noted a significant increase in General vitality, normalization of ejaculation and increased libido. When transrectal Latinoamericana. Analysis gland secretion - leukocytes 2-3 in eyeshot, lecithin grain in large numbers, the phenomenon of crystallization saved.The prostate transrectal us: some heterogeneity echoes, exonerative education is not rendered.When the control urethrocystoscopy (4 weeks after end of treatment) there is a decrease in the intensity of inflammatory changes in the field of seed tubercle, the Central figure is saved, appeared radial vascular pattern in the urethra, glands of Littre and crypts of Morgagni not inflamed, the growth in retrocalcaneal the Department is not defined.The immunological after treatment: SD4= 0,4109/l; IRI=1,5; SD20= 0,3109/l; SD3= 1,2106/l; phosphoinositides in SD3and SD20- 68,4 μm phosphorus/mmol/l and 56.3 μm phosphorus/mmol/l, respectively, interferon -, and -- 160 IU/ml and 64 U/ml, respectively.Control microscopic examination indicated the elimination of chlamydia and Mycoplasma. In the follow-up period (8 months) recurrence of the disease the patient has not occurred. The method of complex treatment of benign tumors of the urethra associated with urogenital the CSOs laser radiation in combination with antibiotic therapy, characterized in that comprehensively implement the immunotherapy of human leukocyte interferon in the form of intramuscular injection of 500 thousand UNITS a day, a course of 10 injections, with the appointment amid immune antibiotic Unidox and Vilprafen in the form of repeated 10-day course of pulse therapy with an interval of 3 days using low-intensity laser radiation with a wavelength of 0.65 μm, an output of 30 mW for 5 - 10 minutes
FIELD: medicine, anesthesiology-resuscitation, infectology, detoxication.
SUBSTANCE: the innovation suggested interrupts infectious-toxic shock, moreover, after that it is necessary to prescribe peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg. Then one should sample patient's blood to obtain leukocytes to be washed and diluted in 0.9%-NaCl solution, activated due to incubation with immunophan and intravenously injected for a patient. Then comes peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg once daily for 5 d. The innovation enables to decrease the number of complications and lethality due to decreasing immunodeficiency.
EFFECT: higher efficiency of therapy.
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